With Health Reform The Next Four Years are Critical

Because of a series of things, Democrat-adverse November elections, Obama’s plummeting ratings , continued 60% disapproval of Obamacare, disruptions inherent in the health care law, resistance in the States to financial and bureaucratic burdens the new law imposes, price hikes of insurance premiums and mounting skepticism of physicians, the implementation of the Accountable Care Act over the next four years will be no cakewalk.

Why four years?

In the first place, most of the big reforms – covering 32 million uninsured and getting the health exchanges in place- do not take effect until 2014.

Secondly, multiple disruptions – patients losing their old plans, spikes in costs, and complaints among consumers and physicians and businesses, health plans and agents dropping out of the market – will be rampant in the 2010-2014 interval.

Here is how CC, Jennings and K.J. Hayes, principals of Jennings Policy Strategies in Washington D.C., describe the reform landscape,

“In the aftermath of the enactment of the Affordable Care Act, President Barack Obama and his administration are walking a policy tightrope; they must implement meaningful reforms in the transition to a stable insurance market without unduly disrupting existing insurance arrangements by means of excessive increases in premiums or declines in coverage.” (“Walking the Tightrope of Health Insurance Reform between 2010 and 2014," NEJM, September 2, 2010).

I wish the Obama team luck. They will need it.

They are dealing with an angry public who are profoundly skeptical about the personal and financial implications of Obamacare. Health plans are hiking premiums to deal with new expenses imposed by the new law, business are negotiating new contracts that shift more costs to consumers.

Physicians are up in arms about regulations and other hassles accompanying the new law.

In an article in the September 1, WSJ, Dr. Hal Scherz, a pediatric urological surgeon at Georgia Urology and Children's Healthcare of Atlanta, who serves on the faculty of Emory University Medical School and as president and co-founder of Docs4PatientCare. says he and thousands of other doctors are giving patients a letter calling for a repeal of Obamacare.

The text of the letter contains this language.

"Dear Patient: Section 1311 of the new health care legislation gives the U.S. Secretary of Health and Human Services and her appointees the power to establish care guidelines that your doctor must abide by or face penalties and fines."

"In making doctors answerable in the federal bureaucracy this bill effectively makes them government employees and means that you and your doctor are no longer in charge of your health care decisions. This new law politicizes medicine and in my opinion destroys the sanctity of the doctor-patient relationship that makes the American health care system the best in the world."

"Despite countless protests by doctors and overwhelming public opposition—up to 60% of Americans opposed this bill—the current party in control of Congress pushed this bill through with legal bribes and Chicago style threats and is determined now to resist any 'repeal and replace' efforts."

"This doctor's office is non-partisan—always has been, always will be. But the fact is that every Republican voted against this bad bill while the Democratic Party leadership and the White House completely dismissed the will of the people in ruthlessly pushing through this legislation."

"In the face of voter anger some Democratic candidates are now trying to make a cosmetic retreat, calling for minor modifications or pretending they are opposed to government-run medicine. Once the election is over, however, they will vote with their party bosses against repealing this bill."

"Please remember when you vote this November that unless the Democratic Party receives a strong negative message about this power grab our health care system will never be fixed and the doctor patient relationship will be ruined forever."

I am not at all sure what impact this letter will have, but it shows the temper of the times among doctors.